What’s Love Got to Do With It?

[Maureen Bonatch MSN, BSN, MSN, RN]

Nurses are often the healthcare professional patients turn to when they’re vulnerable. As the most trusted profession, our patients may confide information during routine care that they wouldn’t normally share. Sometimes vague or questionable information about relationships may be concerning, and raise questions as to whether emotional or physical abuse is occurring. The way we respond to the patient may determine whether they feel validated, or persist in seeking help.

Emotional abuse may be challenging to define, since the signs may be subtle, or absent. Nurses are in a unique position to provide education on early interventions, prevention, and health promotion. Adequate communication, and developing an awareness of signs of emotional abuse, may provide an opportunity to offer guidance and education.

Emotional Abuse

Most of us have been in arguments, or yelled at someone we care about. Often we regret it and apologize later, and sometimes we don’t. These occasional outbursts are normal expressions of emotions. But if yelling or hysterical screaming is the first, and only response, that may be a sign of an unhealthy relationship.

Emotional abuse is an attempt to control the other in a relationship. Often the perpetrator doesn't even realize they’re being emotionally abusive. They may feel insecure and blame the other for their unhappiness, or think they know what’s best. A few potential signs of emotional abuse include when one person in a relationship tends to:

• Respond with criticism
• Attempt to isolate the victim from family and friends
• Make unfounded accusations
• Constantly check on their partner’s whereabouts
• Review their phone, email, and computer history
• Accuse and place blame for their problems
• Humiliate with name calling, and other methods to belittle or embarrass

Gaslighting

Another form of emotional abuse is known as gaslighting. This manipulation tactic to gain power in a relationship makes the victim question their reality. It can occur in a relationship, the workplace, and has been used by abusers and cult leaders. Gaslighting is done slowly so it wears the victim down until they begin to doubt themselves, lose confidence and their own sense of identity. Even if the perpetrator tells lies to distract from their behavior, and deny what the victim knows is the truth, they may be begin to doubt their perception of reality.

Codependency

Codependency can affect the ability to have a healthy relationship. These relationships are often one-sided and emotionally destructive or abusive. Initially this term was used to describe relationships that involved alcohol or drug dependence, but it has since expanded to include relationships with someone who is mentally ill, or from a dysfunctional family.

The victim may neglect their own needs, and their family and friends to support their abuser. This unhealthy behavior has become their normal. They may not know how to respond in any other way. Despite their unhappiness, often they feel guilty, and as if they’re to blame.

Look for Subtle Signs

We may need to confront their own fears, values, attitude and beliefs about abuse to educate themselves about signs of emotional abuse. Personal experiences and cultural upbringings may cause us to overlook the signs, or question why the patient hasn’t taken the steps to end or leave an emotionally abusive relationship. Relationships are stressful and often the victim invests significant energy into preventing the next emotionally abusive episode. They may not want the relationship to end, but want the emotionally abusive behavior to stop.

Nurses can look for subtle physical signs that don’t have an identifiable underlying cause such as stress-related health issues such as digestive issues, headaches, or being evasive to the cause of an injury. Try to communicate with the patient alone in a safe, quiet setting and avoid undermining or judging the victim.

Safety First

Nurses play a role in identifying, and reporting, signs of domestic violence, now often referred to as intimate partner violence (IPV). Even though the majority of victims are women, men can suffer emotional or physical violence as well. Appearances shouldn’t be judged as to who seems more physically intimidating in the relationship and who might be at risk.

Encourage patients who you fear might be in an unhealthy relationship to devise a safety plan if they don’t intend to leave, or a code word for family and friends to indicate they’re in trouble. Provide available hotlines and other resources so they realize that there’s help available.

Increase Awareness

Often patients who may suffer from emotional or physical abuse don’t ask for help, but that doesn’t mean we can’t offer it. Acquiring ongoing education can help increase the awareness of emotional abuse, and the ability to identify the signs of an unhealthy relationship and how to help these patients.

[rachelalexis23]

Many people stay for a variety of reasons (i love him, he says he will change, low self esteem, children are involved) but I believe a lot of times it is fear of the consequences of leaving. Please keep this in mind the most dangerous time for a victim can be when they decide to leave. I know from personal experience as i am sure many on here do, that its a truly terrifying way to live.

[Ruby Vee, BSN]

The thing about emotional abuse is that there isn't an injury about which to be evasive. If your patient is being evasive about injuries, the abuse has escalated to physical abuse. Their physical safety is already compromised.

[Leader25, ASN, BSN, RN]

When the victim refuses to take the next step it is useless to try and force them to except make them feel supported.

[SafetyNurse1968, ADN, BSN, MSN, PhD]

Great article. So appreciate the info about gaslighting. It looks like you and I have similar interests! I'm following you - hope you'll consider following me - it's nice to get some dialogue going.

[FolksBtrippin, BSN, RN]

When we identify "relationship strain" instead of "abuse", we improve access to services.

"Abuse" is very stigmatizing. It's even criminal.

Not saying it isn't an appropriate word or idea in some situations (definitely in physical violence) but not every unhealthy relationship rises to that level.

[Lane Therrell FNP, MSN, RN, NP]

I believe this topic is far more important than generally recognized in healthcare. Unhealthy relationships can be a key contributor to chronic stress, and we all know what chronic stress does to the body... Healthy relationships are created and nurtured by effective interpersonal communication. But who's teaching the "soft" skills?